15 79% of them had M184V, 71 % had NNRTI mutations, (K103N,Y181C,G190A) 60% had TAMS, (M41L,T215Y/F,K70R,L210W,K219E/Q) 11% had Q151M 5% had K65R and 5% had L74V. 26% had 3 or more NNRTI mutations This data clearly warns that patients with immunological failure with standard WHO criteria have severe mutations and which can jeopardize future 2nd line NRTI options and newer drugs. Urgent need for VIRAL LOAD monitoring

20 79% of them had M184V, 71 % had NNRTI mutations, (K103N,Y181C,G190A) 60% had TAMS, (M41L,T215Y/F,K70R,L210W,K219E/Q) 11% had Q151M 5% had K65R and 5% had L74V. 26% had 3 or more NNRTI mutations This data clearly warns that patients with immunological failure with standard WHO criteria have severe mutations and which can jeopardize future 2nd line NRTI options and newer drugs.

23 Suggested indications for resistance testing in India?Baseline testing- Partner on failing regimen Sub-optimal exposure Mono, dual therapy NVP for MTCT Immunologic failure After first line- to know how many TAMs, K65R,NNRTI mutations After second line: how many PI mutations

24 POC resistance testing Point mutation assays may be developed and tailored to widely used first-line,2 nd line regimens. No mutations -Contine the same ART, Improve adherence Mutations- A -Continue same ART, improve adherence Mutations-B -Switch ART Mutations-C -Refer to specialist/tertiary center

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